Gout is a painful condition that affects millions of people every year caused by the extreme saturation of uric acid in the body. It begins with a little known condition called hyperuricemia. Hyperuricemia is an asymptomatic (no visible symptoms) state that is associated with a bigger chance of developing painful gout in a few years. It is NOT gout and in rare cases, gout can develop without passing through the hyperurecemic stage.

In hyperuricemia, there are no dramatic symptoms to be felt yet, but the crystals in the uric acid that cause gout are already coming together. At this stage, your uric acid levels are quite high and they start to deposit themselves in your joint tissues, usually in the toe of the foot, or anywhere in the general foot area. Your doctor may ask you do take necessary steps to stop uric acid from precipitating out of blood and crystallizing in your joints or kidneys. Gout and hyperuricemia pain are compounded by obesity, dramatic weight gain, alcohol intake (especially beer), high blood pressure, irregular kidney function and some drugs. Attacks are also brought about by dehydration, some injuries, high fevers, or surgery.

In the most cases of hyperuricemia, the kidneys under excrete uric acid. On the other hand, some 10% of people with hyperuricemia overproduce uric acid. For some of them, their hyperuricemia is brought about by blood and bone marrow disease or genetic enzyme abnormalities. Sometime, elevated uric acid is genetic Some are hyperurecemic because of obesity, but for most patients, its exact cause is yet to be determined.

Many patients with hyperuricemia do not require medication. They may get "mini" gout attacks in their feet, but the pain is not so debilitating. An attack is usually felt as a severe joint pain at night, often after drinking alcohol or eating high-purine food (like red meat). The pain is usually felt in the big toe, but others may feel it in the heel. Sometimes, it is felt in the hands and wrists. Usually, the pain goes away with diet changes and some medication, but might return in a year. In the period between these attacks, they have to avoid foods high in purines and strive to reach a healthy weight. It is also imperative that they stop drinking beer altogether and reduce any stress.

A number of effective anti-hyperurecemic agents are available, but not usually advisable if the attacks are still negligible. Allopurinol is used to inhibit uric acid production and is useful for patients who are diagnosed with kidney disorders. The decision to use anti-hyperurecemic drugs is usually not done if hyperuricemia is mild. Sometimes the doctor waits until the patient has had two attacks. Even so, one must keep in mind that anti-hyperurecemic therapy is for life and may be difficult to stick to.

There is hope, however. Only a few (one in four) people with hyperuricemia go on to develop full blown gout because early awareness helps them alter the disease's course with proper diet and/or medication. But if you notice an increased frequency and duration of hyperuricemia, gout may be inevitable. See your doctor regularly so both of you can work out an approach that is beneficial for you in the long run.

Michael Russell

Your Independent guide to Health